Kafazi Alkmena, Apostolopoulou Eleni, Benetou Vasiliki, Kourlaba Georgia, Stylianou Christos, Pavlopoulou Ioanna D
Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece.
Medical School, National and Kapodistrian University of Athens, Athens, Greece.
J Crit Care Med (Targu Mures). 2024 Apr 30;10(2):168-176. doi: 10.2478/jccm-2024-0016. eCollection 2024 Apr.
Cost analysis is complicated by the fact that patients acquire infections during their hospital stay, having already spent time at risk without having an infection. Multi-state models (MSM) accounts for this time at risk treating infections as time-dependent exposures from ICU admission.
To estimate ventilator-associated events (VAEs) direct additional cost in ICU patients.
This was a prospective, observational study carried out for a two-year period in four medical-surgical ICUs of Athens, Greece. The sample consisted of adult patients who received mechanical ventilation for ≥4 days and were followed until discharge from the ICU or until death. CDC standard definitions were used to diagnose VAEs. To estimate VAEs additional length of stay (LOS), we used a four-state model that accounted for the time of VAEs. The direct hospital cost was calculated, consisting of the fixed and variable cost. The direct additional cost per VAEs episode was calculated by multiplying VAEs extra LOS by cost per day of ICU hospitalization.
In the final analysis were included 378 patients with 9,369 patient-days. The majority of patients were male (58.7%) with a median age of 60 years. Of 378 patients 143 (37.8%) developed 143 episodes of VAEs. VAEs crude additional LOS was 17 days, while VAE mean additional LOS after applying MSM was 6.55±1.78 days. The direct cost per day of ICU hospitalization was € 492.80. The direct additional cost per VAEs episode was € 3,227.84, € 885.56 the fixed and € 2,342.28 the variable cost. Antibiotic cost was € 1,570.95 per VAEs episode. The total direct additional cost for the two-year period was € 461,581.12.
These results confirm the importance of estimating VAEs real cost using micro-costing for analytical cost allocation, and MSM to avoid additional LOS and cost overestimation.
成本分析因患者在住院期间获得感染这一事实而变得复杂，他们在有感染风险的情况下已经度过了一段时间却未感染。多状态模型（MSM）将这段有风险的时间考虑在内，将感染视为从重症监护病房（ICU）入院起的时间依赖性暴露因素。
估计ICU患者呼吸机相关事件（VAE）的直接额外成本。
这是一项在希腊雅典的四个内科 - 外科ICU进行的为期两年的前瞻性观察性研究。样本包括接受机械通气≥4天的成年患者，并随访至从ICU出院或死亡。采用美国疾病控制与预防中心（CDC）的标准定义来诊断VAE。为了估计VAE的额外住院时间（LOS），我们使用了一个考虑VAE发生时间的四状态模型。计算了直接医院成本，包括固定成本和可变成本。每个VAE事件的直接额外成本通过将VAE额外住院时间乘以ICU住院每天的成本来计算。
最终分析纳入了378例患者，共9369个患者日。大多数患者为男性（58.7%），中位年龄为60岁。在378例患者中，143例（37.8%）发生了143次VAE事件。VAE的粗略额外住院时间为17天，而应用MSM后的VAE平均额外住院时间为6.55±1.78天。ICU住院每天的直接成本为492.80欧元。每个VAE事件的直接额外成本为3227.84欧元，其中固定成本为885.56欧元，可变成本为2342.28欧元。每次VAE事件的抗生素成本为1570.95欧元。两年期间的总直接额外成本为461581.12欧元。
这些结果证实了使用微观成本核算进行分析成本分配以及使用MSM来避免额外住院时间和成本高估以估计VAE实际成本的重要性。
